Remote Leader, Utilization Management

TriWest Healthcare Alliance; Phoenix (AZ); On-site; USD 91,000 - 107,000; Full time

Benefits offered by this job

Medical, Dental and Vision Coverage

Paid time off

401(k) with matching

Disability insurance

Tuition reimbursement

Paid volunteer time

Job summary

TriWest Healthcare Alliance is seeking an RN to supervise daily Utilization Management operations for the DoD/TRICARE contract. The role coordinates across teams to ensure timeliness, quality care, and accreditation standards.

Requirements include an active registered nurse license, 3+ years in healthcare with leadership experience, and familiarity with utilization review criteria. This role supports remote work options and requires US citizenship.

Qualifications

• RN license with current, unrestricted status.
• 3+ years in healthcare environment.
• 3+ years supervisory or leadership experience in healthcare.
• 2+ years utilization review or case management.
• U.S. Citizenship required.
• Must be able to obtain favorable DoD background investigation.

Responsibilities

• Supervise day-to-day Utilization Management operations.
• Ensure staff aware of changes and policy revisions.
• Prepare schedules and monitor caseloads for adequate staffing.
• Monitor adherence to criteria and contract requirements.
• Prepare and analyze UM activity reports.
• Collaborate with clinical operations and contracted partners.

Skills

Leadership

Staff supervision

Communication skills

InterQual criteria

Microsoft Office

Clinical knowledge

Education

Registered Nurse license

Tools

InterQual

Medical management systems

Microsoft Office

Job description

TriWest Healthcare Alliance is seeking an RN to supervise daily Utilization Management operations for the DoD/TRICARE contract. The role coordinates across teams to ensure timeliness, quality care, and accreditation standards.

Requirements include an active registered nurse license, 3+ years in healthcare with leadership experience, and familiarity with utilization review criteria. This role supports remote work options and requires US citizenship.